@extends('layouts.master')
@section('head')
	@parent
	<title>FACT - Register</title>
@stop

@section('content')		
	<div class="main">
      <div class="shop_top">
	     <div class="container">
						<form> 
								<div class="register-top-grid">
										<h3>PERSONAL INFORMATION</h3>
										<div>
											<span>First Name<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Middle Initial<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Last Name<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Age<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Email Address<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Facebook Account<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Year Graduate<label>*</label></span>
											<input type="text"> 
										</div>
										<div>
											<span>Contact Number</span>
											<input type="text"> 
										</div>
										
										
										
										<div class="clear"> </div>
											
								</div>
								<div class="clear"> </div>
								<div class="register-bottom-grid">
										<h3>LOGIN INFORMATION</h3>
										<div>
											<span>Password<label>*</label></span>
											<input type="text">
										</div>
										<div>
											<span>Confirm Password<label>*</label></span>
											<input type="text">
										</div>
										<div class="clear"> </div>
								</div>
								<div class="clear"> </div>
								<input type="submit" value="submit">
						</form>
					</div>
		   </div>
	  </div>		
@stop